Inpatient falls constitute a major clinical, supervisory, and legal issue, though not much information exists on the subject of successful fall reductions (Rosenthal, 2007). CMS (Centers for Medicare and Medicaid Services) has ceased to reimburse healthcare facilities for traumatic inpatient falls. With increased aging of the American population, preventing falls has become more important than ever before. Elderly, weak patients depict greater risk of falls, with more serious consequences. Fall prevention within the nation’s acute care facilities gives rise to distinctive challenges, considering the fact that it involves severely ailing patients with an average hospital stay of a mere 4.9 days. Such a compressed acuity increases healthcare practitioners’ burden to ensure patient safety; thus, fall prevention intervention results for long-term patient care organizations might not be applicable to facilities providing acute care. Likewise, international results might probably not be generalizable to the American context, as international hospitalization durations tend to be longer. Fall prevention initiatives are generally multifaceted and involve a number of aspects dependent on leader participation and multi-disciplinary frontline employee cooperation. Initiatives might call for sound monitoring plans for ensuring hospital employees abide by established patient care rules (Hampel et al, 2013). For facilitating identification of patients’ fall risk factors and guiding fall prevention initiatives within the acute care context, falls are generally classified into the following categories: expected physiologic falls, accidental falls, or unexpected physiologic falls. Further, risk factors are also grouped as extrinsic or intrinsic, the latter including:

· Low endurance of physical exertion

· Orthostatic hypotension or decrease in blood pressure due to dehydration, standing, or lower extremity muscular weakness

· Reduced mobility, poor balance, or unsteady walk on account of neurologic conditions, pain, or musculoskeletal abnormalities

· Foot issues which lead to peripheral neuropathy (paresthesia) or pain

· Vision impairment on account of glaucoma, cataract or low depth perception

Extrinsic factors or factors with external origins include physical environmental conditions (e.g., inadequate lighting, slippery floor because of any kind of spill, irregular threshold, or clutter) (American Nurse Today, 2015).

Implementation of a Falls Prevention Program

A complex, multidisciplinary strategy was adopted for formulating...

Firstly, baseline information was noted and studied for determining problem magnitude. The information gleaned was communicated to every team member; subsequently, team members relied on individual clinical networks for creating initiative awareness among the remaining employees. The initiative was of a policy-driven nature (i.e., in line with the 2003 WADOH (Western Australian Department of Health) Fall Prevention Policy). The policy’s publication prompted the creation of a healthcare organizational Falls Risk Management Policy. The subsequent step involved creating and putting into place an official post-fall evaluation procedure, deemed appropriate in a group consensus meeting. Normally, risk evaluation entails admission evaluation for established risks, focusing on patient mobility and psychological status in relation to age, post-surgical condition or medications administered (McCarter-Bayer et al., 2005; Zdobysz et al., 2005). But in spite of such risk awareness, a large number of risk evaluation instruments have proven imprecise or shown limited effectiveness owing to diverse factors’ / units’ variability (e.g., new recruits, occupancy rates, and patient acuity).
Here, it was essential to develop the risk evaluation instrument based on local patient flow awareness, physical layout of the healthcare facility, resources (like working relationships between fall prevention initiative team members) and environmental elements. This facilitated initiative contextualization to the distinct setting, besides enhancing inter- and intra- disciplinary communication (which isn’t invariably easily achievable within larger hospital settings) (Woloshynowych, Rogers, Taylor-Adams & Vincent, 2005).

The CFR (Clinical Fall Review) evaluation form was created using the contributions of every team member. It aids hospital employees in reevaluating the range of possible causes and, wherever relevant, prompts allied health or pharmacy referrals. Causative factor evaluation includes: patient’s mobility and need for manual handling; clinical elements like tests and urinalysis; risk of falls (which includes hazardous footwear); environmental elements (including hi-lo adjustable beds and bedrails wherever possible, and concentration of obstacles within patient bathrooms and bedrooms); and pharmacological elements (hypnotic or opioid medication commencement, multiple drug alterations since hospitalization, or poly-pharmacy). Nurse care plan reforms for reflecting falls evaluation information offered clinical staff members with fresh prompts to remain cognizant of…